Comparison of the effects of the unilateral and the bilateral percutaneous kyphoplasty therapies in the treatment of the osteoporotic thoracic vertebral fracture with intercostal pain
Zhang Cheng1, Ma Chao2,3, Chen Tao4
1Graduate School of Xuzhou Medical University, Xuzhou 221004, China; 2Xuzhou Clinical College of Xuzhou Medical University, Xuzhou 221009,China; 3Department of Spinal Surgery, Xuzhou Central Hospital, Xuzhou 221009, China; 4Graduate School of Bengbu Medical College, Bengbu 233030, China
Abstract:Objective This study aims to compare the clinical effects of the unilateral and the bilateral percutaneous kyphoplasty therapies for the treatment of osteoporotic thoracic compression fracture (OVCF) with intercostal pain.Methods A retrospective analysis was performed on the clinical data of 63 patients with OVCF (25 males and 38 females aged 61-93 years) undergoing percutaneous kyphoplasty in Xuzhou Central Hospital from September 2016 to September 2019. Patients were divided into the unilateral (36 cases) and the bilateral (27 cases) groups in accordance with the different surgical paths. The operative time, amount of injected bone cement, leakage rate of bone cement, recovery rate of vertebral height, improvement degree of postoperative Cobb Angle, and complications in the two groups were observed. The visual analog scale (VAS) scores and the Oswestry disability indices (ODI) preoperative and the first day, 1 month, and 3 months postoperative were compared.Results No statistically significant difference between the two groups was observed in terms of baseline data, such as age, gender, and vertebral injury distribution (all P values>0.05). The amount of operating time and injection of bone cement of the unilateral group ([31.75±6.60] min and [4.07±0.52] mL respectively) were significantly less than those of the bilateral group ([38.96±6.77] min and [5.65±0.51] mL, respectively; t=4.242, 11.863; all P values<0.05). The postoperative bone cement leakage rate of the unilateral group (27.8%, 10/36) was significantly higher than that of the bilateral group (7.4%, 2/27; χ2=4.152, P<0.05). No statistically significant difference was observed between the two groups in terms of the recovery rate of the vertebral height and the improvement degree of the Cobb Angle in the injured vertebra after the operation (all P values>0.05). All patients were followed up for 1-3 months. No obvious complications, such as nerve injury, spinal cord injury, puncture hematoma, and infection, were found during and after the operation. The lower back pain, intercostal VAS score, and ODI of patients in the two groups significantly improved compared with those before surgery at each follow-up time point (all P values<0.05). The comparison of VAS scores and ODI of lower back pain between the unilateral and the bilateral groups showed no significant difference before and 1 day, 1 month, and 3 months after the surgery (all P values>0.05). The comparison of VAS score and ODI of intercostal pain showed that both groups were significantly lower than the unilateral group 1 day and 1 month after surgery (all P values<0.05), and no significant difference was observed between the preoperative and the 3 months postoperative (all P values>0.05).Conclusions The unilateral and the bilateral transdermal kyphoplasty therapies for the treatment of OVCF with intercostal pain have similar analgesic and spinal stability recovery effects, but the bilateral approach, which is a safer and more reliable method, has lower bone cement leakage rate and is more effective in early postoperative relief of intercostal pain than the unilateral approach.
张成, 马超, 陈涛. 单、双侧入路经皮椎体后凸成形术治疗骨质疏松性胸椎骨折伴肋间痛的疗效比较[J]. 中华解剖与临床杂志, 2021, 26(3): 314-319.
Zhang Cheng, Ma Chao, Chen Tao. Comparison of the effects of the unilateral and the bilateral percutaneous kyphoplasty therapies in the treatment of the osteoporotic thoracic vertebral fracture with intercostal pain. Chinese Journal of Anatomy and Clinics, 2021, 26(3): 314-319.
Russell LA. Management of difficult osteoporosis[J]. Best Pract Res Clin Rheumatol, 2018, 32(6): 835-847. DOI:10.1016/j.berh.2019.04.002.
[2]
Jung HJ, Park YS, Seo HY, et al. Quality of life in patients with osteoporotic vertebral compression fractures[J]. J Bone Metab, 2017, 24(3): 187-196. DOI:10.11005/jbm.2017.24.3.187.
Sheng CH, Li TK, Wang JJ, et al. Unilateral versus bilateral puncture in percutaneous kyphoplasty for osteoporotic vertebral compression fracture[J]. Orthopedic Journal of China, 2018, 26(12): 1094-1097. DOI:10.3977/j.issn.1005-8478.2018.12.08.
[4]
Epstein NE. A comparison of kyphoplasty, vertebroplasty, or non-surgical treatment of traumatic/atraumatic osteoporotic vertebral compression fractures: a short review[J]. Surg Neurol Int, 2019, 10: 54. DOI:10.25259/SNI-123-2019.
[5]
Tan G, Li F, Zhou D, et al. Unilateral versus bilateral percutaneous balloon kyphoplasty for osteoporotic vertebral compression fractures: a systematic review of overlapping meta-analyses[J]. Medicine (Baltimore), 2018, 97(33): e11968. DOI:10.1097/MD.0000000000011968.
[6]
Spiegl U, Schnake KJ, Hartmann F, et al. Traumatic fractures of the thoracic spine[J]. Z Orthop Unfall, 2020, DOI:10.1055/a-1144-3846.
[7]
Kida K, Tani T, Kawazoe T, et al. Thoracic radicular pain caused by extravertebral gas and fluid collections associated with osteoporotic vertebral fracture containing a vacuum cleft[J]. Case Rep Orthop, 2019, 2019: 4284217. DOI:10.1155/2019/4284217.
[8]
Genant HK, Wu CY, van Kuijk C, et al. Vertebral fracture assessment using a semiquantitative technique[J]. J Bone Miner Res, 1993, 8(9): 1137-1148. DOI:10.1002/jbmr.5650080915.
[9]
Zhu RS, Kan SL, Ning GZ, et al. Which is the best treatment of osteoporotic vertebral compression fractures: balloon kyphoplasty, percutaneous vertebroplasty, or non-surgical treatment? A Bayesian network meta-analysis[J]. Osteoporos Int, 2019, 30(2): 287-298. DOI:10.1007/s00198-018-4804-2.
[10]
Martikos K, Greggi T, Vommaro F, et al. Vertebroplasty in the treatment of osteoporotic vertebral compression fractures: patient selection and perspectives[J]. Open Access Rheumatol, 2019, 11: 157-161. DOI:10.2147/OARRR.S174424.
[11]
Pezeshki, PS; Davidson, S; Murphy, K; et al.Comparison of the effect of two different bone-targeted radiofrequency ablation (RFA) systems alone and in combination with percutaneous vertebroplasty (PVP) on the biomechanical stability of the metastatic spine.[J]. Eur Spine J. 2016, 25(12): 3990-3996. DOI:10.1007/s00586-015-4057-0.
Liu Q. Clinical efficacy of percutaneous kyphoplasty for osteoporotic vertebral fracture without significant compression[J]. Chinese Remedies & Clinics, 2019, 19(11): 1844-1846. DOI:10.11655/zgywylc2019.11.040.
Zhang YZ, Hu J, Qiu LX, et al. Clinical observation of PKP in the treatment of senile osteoporotic vertebral fracture[J]. Heilongjiang Medicine Journal, 2019, 32(6): 1463-1465. DOI:10.14035/j.cnki.hljyy.2019.06.097.
[14]
Leggat PA, Smith DR, Kedjarune U. Surgical applications of methyl methacrylate: a review of toxicity[J]. Arch Environ Occup Health, 2009, 64(3): 207-212. DOI:10.1080/19338240903241291.
[15]
Deramond H, Wright NT, Belkoff SM. Temperature elevation caused by bone cement polymerization during vertebroplasty.[J]. Bone. 1999, 25: 17S-21S. DOI:10.1016/s8756-3282(99)00127-1.
Qiu H J, Yu L W, Li L H, et al. Clinical effect of unilateral bilateral puncture percutaneous kyphoplasty for osteoporotic vertebral compression fracture[J]. Journal of Bethune Military Medical College, 2017, 15(6): 4. DOI:10.16485/j.issn.2095-7858.2017.06.014.
Hao HH, Wu D, Zhu J, et al. Contrastive analysis of the unipedicular and bipedicular kyphoplasty in treatment of osteoporotic vertebral compression fracture[J]. Chinese Journal of Geriatric Orthopedics & Rehabilitation, 2017, 3(6): 321-326. DOI:10.3877/cma.j.issn.2096-0263.2017.06.001.
Xue W. Comparison of the effect of unilateral and bilateral percutaneous puncture vertebroplasty on osteoporotic thoracolumbar vertebral compression fractures[J]. Journal of Xinxiang Medical College, 2017, 34(1): 69-71. DOI:10.7683/xxyxyxb.2017.01.020.
Li L, Zhou ZX, Liu AP, et al. Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures[J]. Journal of Clinical Orthopaedics, 2017, 20(1): 26-28, 29. DOI:10.3969/j.issn.1008-0287.2017.01.013.
Zhao L, Wang GR, Zheng SN, et al. Comparison effect of unilateral and bilateral puncture of percutaneous kyphoplasty in the treatment of multiple osteoporotic vertebral compression fractures[J]. Journal of Clinical Orthopaedics, 2019, 22(6): 650-654. DOI:10.3969/j.issn.1008-0287.2019.06.004.
[21]
Tang J, Guo WC, Hu JF, et al. Unilateral and bilateral percutaneous kyphoplasty for thoracolumbar osteoporotic compression fractures[J]. J Coll Physicians Surg Pak, 2019, 29(10): 946-950. DOI:10.29271/jcpsp.2019.10.946.